1
|
Kick L, Schleicher D, Ecker A, Kandsperger S, Brunner R, Jarvers I. Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Front Psychiatry 2024; 15:1412229. [PMID: 39011338 PMCID: PMC11246998 DOI: 10.3389/fpsyt.2024.1412229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions. Methods In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated. Results The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse. Discussion These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.
Collapse
Affiliation(s)
- Lorenz Kick
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stephanie Kandsperger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| |
Collapse
|
2
|
Kindermann D, Rollmann I, Orth M, Friederich HC, Nikendei C. Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy. Psychother Res 2024; 34:774-789. [PMID: 37706484 DOI: 10.1080/10503307.2023.2254917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy. We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor. The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate. Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.
Collapse
Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Orth
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
3
|
Liu Y, Zhang C, Li M, Gao Y, Wang Y, Liu X, Li J. Exploring specific associations of childhood maltreatment with social cognition in drug-naive first-episode major depressive disorder: a sex-centric approach. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01723-6. [PMID: 38038762 DOI: 10.1007/s00406-023-01723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023]
Abstract
Childhood maltreatment (CM) has been linked to social cognition deficits in major depressive disorder (MDD), but little is known about sex-specific effects. This study aimed to investigate the sex-specific associations of CM with social cognition in first-episode drug-naive patients with MDD. A total of 117 first-episode drug-naive patients with MDD and 134 healthy controls (HCs) were recruited and assessed for demographic and clinical characteristics. All participants completed the Childhood Trauma Questionnaire (CTQ), Toronto Alexithymia Scale (TAS-20), Interpersonal Reactivity Index-C (IRI), and Facial Emotion Recognition Test. Partial correlation analysis was used to explore the sex-specific association of CM with social cognition. Our findings revealed significant differences in the associations of CM with social cognition between males and females in MDD patients. In comparison to HCs, the associations of CM with social cognition displayed distinct and even contrasting sex-specific patterns in MDD patients. Specifically, male MDD patients exhibited unique imbalanced associations between emotional neglect and alexithymia, while both female and male MDD patients shared imbalanced associations of childhood abuse with empathy. These results emphasize the importance of considering the sex-specific associations of CM with social cognition in MDD and highlight the need for personalized interventions and treatments based on sex for MDD patients with a history of CM.
Collapse
Affiliation(s)
- Yuan Liu
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Chuhao Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Meijuan Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Ying Gao
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Yuting Wang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Xueying Liu
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin RdHexi District, Tianjin, 300222, China.
| |
Collapse
|
4
|
Freiherr von Schoenhueb D, Boecking B, Mazurek B. Alexithymia in Patients with Somatization Difficulties and Tinnitus-Related Distress: A Systematic Review. J Clin Med 2023; 12:6828. [PMID: 37959295 PMCID: PMC10649228 DOI: 10.3390/jcm12216828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom, chronic tinnitus can present as a "somatoform" or "functional" difficulty. Some evidence has pointed to alexithymia as a transdiagnostically relevant risk factor for both symptom clusters. Using a two-part rapid review-searching within EBSCO, Embase by Ovid, PubMed, Web of Science-we summarize psychological studies regarding alexithymia, i.e., difficulties in recognizing and expressing emotions and (1) somatoform conditions and (2) chronic tinnitus. For the former (inclusion criteria: (1) adult human beings with different kinds of somatization, (2) longitudinal study designs, (3) publication between 2001 and 2021, (4) full-text in English or German) we identified eight studies that revealed significant links between alexithymia and somatoform conditions. Psychotherapy improved alexithymia in most studies. Additionally, alexithymia was associated with broader treatment outcomes such as improvements in pain intensity, gastrointestinal symptoms, and patient-therapist alliance. The 'Risk Of Bias In Non-randomized Studies-of Interventions' tool (ROBINS-I) and 'Revised Cochrane risk-of-bias tool for randomized trials' (RoB 2) were used for risk of bias assessment. Summarizing all available studies on alexithymia and chronic tinnitus, we identified three studies. Inclusion criteria were: (1) adult human beings with chronic tinnitus, (2) publication between 2001 and 2021, (3) full-text in English or German. Risk of bias was assessed by the 'JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies'. The available studies suggested a high rate of alexithymia (65.7%) in patients with chronic tinnitus. Tinnitus-related distress was significantly associated with alexithymia in two studies, one of which, however, found no differences in alexithymia between patients with bothersome versus non-bothersome tinnitus. Conversely, one study reported high levels of alexithymia in patients with low levels of tinnitus-related distress. Overall, alexithymia may be a transdiagnostic psychological indicator of somatization phenomena, which might include some chronic tinnitus presentations. Psychotherapy likely improves alexithymia as well as somatoform symptom presentations.
Collapse
Affiliation(s)
| | | | - Birgit Mazurek
- Tinnitus Center, Charité—Universitatsmedizin Berlin, 10117 Berlin, Germany; (D.F.v.S.); (B.B.)
| |
Collapse
|
5
|
Wolff B, Franco VR, Magiati I, Pestell CF, Glasson EJ. Psychosocial and neurocognitive correlates of suicidal thoughts and behaviours amongst siblings of persons with and without neurodevelopmental conditions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104566. [PMID: 37441861 DOI: 10.1016/j.ridd.2023.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of neuropsychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis (WHO, 2014) and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap. METHOD The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviours amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14-27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests. RESULTS NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = -0.32), suicidal ideation (25.76% versus 8.89%, δ = -0.40) and history of suicide attempts (18.18% versus 4.44%, δ = -0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86-0.91, negative predictive value 0.81-0.90, false negative rates 0.11-0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality. CONCLUSIONS Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.
Collapse
Affiliation(s)
- Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Australia; Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
| | | | - Iliana Magiati
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia; Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
6
|
Cecchetto C, Dal Bò E, Aiello M, Fischmeister FPS, Gentili C, Osimo SA. Alexithymia modulates the attitudes towards odors but not the olfactory abilities or the affective reactions to odors. PLoS One 2023; 18:e0278496. [PMID: 37279254 DOI: 10.1371/journal.pone.0278496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
Although emotion and olfaction are closely linked, only a few studies have investigated olfactory processing in alexithymia, a condition characterized by altered emotional processing. These results do not allow comprehensive conclusions on whether individuals with alexithymia present lower olfactory abilities or only altered affective reactions and awareness of odors. Three pre-registered experiments were conducted to clarify this relation. We assessed olfactory functions, the affective qualities of odors, the awareness of odors, the attitudes towards them, and the ability to form olfactory images in the mind. Bayesian statistics were used to assess differences between low, medium and high alexithymia groups, and Linear Mixed Models (LMMs) were applied to investigate the modulation of the affective and cognitive components of alexithymia. We observed that individuals with a high level of alexithymia presented the same olfactory abilities, and did not show differences in their rating of odors compared to individuals with low alexithymia levels, while they reported lower levels of social and common odor awareness and a more indifferent attitude towards odors. Olfactory imagery was not affected by alexithymia level, and the affective and cognitive components of alexithymia, when considered separately, modulated olfactory perception differently. Learning more about olfactory perception in individuals with alexithymia leads to a better understanding of how alexithymia impacts the perception of hedonic stimuli coming from different sensory modalities. Our results imply that treatment goals for alexithymia should be the enhancement of the conscious perception of odors, supporting the use of mindfulness-based protocols in the alexithymia treatment.
Collapse
Affiliation(s)
- Cinzia Cecchetto
- Department of General Psychology, University of Padua, Padua, Italy
| | - Elisa Dal Bò
- Department of General Psychology, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Marilena Aiello
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Florian Ph S Fischmeister
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Sofia Adelaide Osimo
- Department of Psychology, MibTec, Università degli Studi di Milano-Bicocca, Milan, Italy
| |
Collapse
|
7
|
Wolff B, Franco VR, Magiati I, Cooper MN, Roberts R, Skoss R, Glasson EJ. Individual-Level Risk and Resilience Factors Associated with Mental Health in Siblings of Individuals with Neurodevelopmental Conditions: A Network Analysis. Dev Neuropsychol 2023; 48:112-134. [PMID: 36942456 DOI: 10.1080/87565641.2023.2190119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Siblings of individuals with neurodevelopmental conditions (NDCs) are exposed to unique family environments and experience a range of psychosocial risk and resilience factors. Networks of self-reported risk, resilience, and neuropsychiatric variables were estimated for siblings of individuals with (n = 235) and without (n = 480) NDCs (N = 715, mean age 22.40 years, 76% female, 74% White Caucasian). The NDC group reported more depressive (g = 0.39) and anxious (g = 0.43) symptoms than controls, and 71.5% of the NDC group reported at least one neuropsychiatric diagnosis compared to 36.9% of controls. Self-reported sleep and post-traumatic stress disorders were high amongst NDC siblings. Everyday executive functioning difficulties (cognitive inflexibility, hyperactivity/impulsivity) and emotion dysregulation were the most influential transdiagnostic risk factors for poorer functioning within the NDC group network.
Collapse
Affiliation(s)
- Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Australia
- Telethon Kids Institute , Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Vithor R Franco
- Department of Psych ology, São Francisco University, Campinas, Brazil
| | - Iliana Magiati
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Matthew N Cooper
- Telethon Kids Institute , Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Rachel Roberts
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Rachel Skoss
- Telethon Kids Institute , Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia
| | - Emma J Glasson
- Telethon Kids Institute , Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, WA, Perth, Australia
| |
Collapse
|
8
|
Ferguson CJ, Preece DA, Schweitzer RD. Alexithymia in autism spectrum disorder. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2174409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Cassie J. Ferguson
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - David A. Preece
- Curtin enAble Institute and School of Population Health, Curtin University, Perth, Australia
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Robert D. Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
9
|
Sommerfeld E. Patients’ response to moments of disappointment with their therapist: the roles of disappointment experience, emotional abilities, and perceived alliance negotiation. Psychother Res 2022; 33:566-580. [DOI: 10.1080/10503307.2022.2144526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
10
|
Akram A, Arshad T. Alexithymia Reduction Treatment: A pilot quasi‐experimental study for remediation of alexithymia and its consequent effects on the general mental health of university students. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ayesha Akram
- Centre for Clinical Psychology University of the Punjab Lahore Pakistan
| | - Tehreem Arshad
- Centre for Clinical Psychology University of the Punjab Lahore Pakistan
| |
Collapse
|
11
|
Larionow P, Preece DA, Mudło-Głagolska K. Assessing alexithymia across negative and positive emotions: Psychometric properties of the Polish version of the Perth Alexithymia Questionnaire. Front Psychiatry 2022; 13:1047191. [PMID: 36532198 PMCID: PMC9748568 DOI: 10.3389/fpsyt.2022.1047191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
The Perth Alexithymia Questionnaire (PAQ) is a 24-item self-report measure of alexithymia. Originally developed in English, it was designed to try to enable more comprehensive (i.e., facet-level and valence-specific) alexithymia assessments. This study aimed to introduce and validate a Polish version of the PAQ. Our sample were 1,008 people (69.44% females, 30.06% males and 0.50% non-binary) aged 18-78 (M = 29.69, SD = 14.15) from the general community. The PAQ's factor structure was verified with confirmatory factor analysis, and convergent and divergent validity were assessed via relationships with other measures of alexithymia and mental health symptoms. Our results indicated strong factorial validity, conforming to the intended subscale structure. As expected, all PAQ subscales correlated in expected directions with another established alexithymia measure, and markers of depression, anxiety, and stress symptoms. The PAQ showed good discriminant validity in terms of measuring an alexithymia construct that was separable from people's current level of distress. Test-retest and internal consistency reliabilities were also good. Overall, the Polish PAQ therefore appears to have strong psychometric properties. Our findings add to a growing body of literature supporting the validity of the PAQ, and the multidimensional nature of the alexithymia construct, across different nations and languages.
Collapse
Affiliation(s)
- Paweł Larionow
- Faculty of Psychology, Kazimierz Wielki University, Bydgoszcz, Poland
| | - David A Preece
- Faculty of Health Sciences, School of Population Health, Curtin University, Perth, WA, Australia.,School of Psychological Science, The University of Western Australia, Perth, WA, Australia.,Brain and Behaviour Division, Telethon Kids Institute, Perth, WA, Australia
| | | |
Collapse
|
12
|
Luminet O, Nielson KA, Ridout N. Cognitive-emotional processing in alexithymia: an integrative review. Cogn Emot 2021; 35:449-487. [PMID: 33787442 DOI: 10.1080/02699931.2021.1908231] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alexithymia is a multifaceted personality construct characterised by difficulties identifying one's feelings and distinguishing them from bodily sensations, difficulties describing one's feelings to others, and an externally oriented cognitive style. Over the past 25 years, a burgeoning body of research has examined how alexithymia moderates processing at the cognition-emotion interface. We review the findings in five domains: attention, appraisals, memory, language, and behaviours. The preponderance of studies linked alexithymia with deficits in emotion processing, which was apparent across all domains, except behaviours. All studies on behaviours and a proportion of studies in other domains demonstrated emotional over-responding. Analysis at the facet level revealed deficits in memory and language that are primarily associated with externally oriented thinking, while over-responding was most often linked to difficulty identifying feelings and difficulty describing feelings. The review also found evidence for contextual modulation: The pattern of deficits and over-responding was not restricted to emotional contexts but also occurred in neutral contexts, and in some circumstances, emotional over-responding in alexithymia was beneficial. Taken together, this review highlights alexithymia as a central personality dimension in the interplay between cognition and emotion.
Collapse
Affiliation(s)
- Olivier Luminet
- Research Institute for Psychological Sciences, UCLouvain, Louvain-la-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Belgium
| | - Kristy A Nielson
- Department of Psychology, Marquette University, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ridout
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK
| |
Collapse
|
13
|
Nunes da Silva A. Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines. Psychopathology 2021; 54:282-290. [PMID: 34749373 DOI: 10.1159/000519786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022]
Abstract
Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This article aimed to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians' current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.
Collapse
|
14
|
Abstract
Humans are highly adept at differentiating, regulating, and responding to their emotions. At the core of all these functions is emotional awareness: the conscious feeling states that are central to human mental life. Disrupted emotional awareness-a subclinical construct commonly referred to as alexithymia-is present in a range of psychiatric and neurological disorders and can have a deleterious impact on functional outcomes and treatment response. This chapter is a selective review of the current state of the science on alexithymia. We focus on two separate but related issues: (i) the functional deficits associated with alexithymia and what they reveal about the importance of emotional awareness for shaping normative human functioning, and (ii) the neural correlates of alexithymia and what they can inform us about the biological bases of emotional awareness. Lastly, we outline challenges and opportunities for alexithymia research, focusing on measurement issues and the potential utility of formal computational models of emotional awareness for advancing the fields of clinical and affective science.
Collapse
Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM, United States.
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, United States; Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
15
|
Becerra R, Baeza CG, Fernandez AM, Preece DA. Assessing Alexithymia: Psychometric Properties of the Perth Alexithymia Questionnaire in a Spanish-Speaking Sample. Front Psychiatry 2021; 12:710398. [PMID: 34712154 PMCID: PMC8545878 DOI: 10.3389/fpsyt.2021.710398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Alexithymia is a trait composed of difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally orientated thinking (EOT). It is an important transdiagnostic risk factor for psychosomatic disorders and other types of emotion-based psychopathologies, and can reduce the efficacy of some treatment approaches. Alexithymia assessments are therefore important in psychiatric and research settings. The Perth Alexithymia Questionnaire (PAQ) was recently developed to enable more comprehensive alexithymia assessments, however, its psychometric properties need further examination and it is so far only available in English. In this study, we sought to address this by translating the PAQ into Spanish and testing its psychometric properties in an adult sample from Chile (N = 370). Confirmatory factor analyses found the PAQ to have a theoretically congruent factor structure, supporting the contemporary status of alexithymia as a multifaceted construct and the PAQ's capacity to assess the DIF, DDF, and EOT facets of alexithymia across negative and positive emotions. All subscale and composite scores had high internal consistency reliability, and demonstrated good concurrent and discriminant validity. The PAQ therefore appears to provide a robust and detailed alexithymia profile. This Spanish version should help to enable more comprehensive cross-cultural research into alexithymia and its role in and psychological disorders.
Collapse
Affiliation(s)
- Rodrigo Becerra
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | | | | | - David A Preece
- School of Psychological Science, University of Western Australia, Perth, WA, Australia.,School of Psychology, Curtin University, Perth, WA, Australia
| |
Collapse
|
16
|
Silva AN, Branco Vasco A, Watson JC. Alexithymia and change process: Contributions of a phase model. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ana Nunes Silva
- Faculdade de Psicologia Universidade de Lisboa Lisboa Portugal
| | | | - Jeanne C. Watson
- Ontario Institute for Studies in Education University of Toronto Toronto ON Canada
| |
Collapse
|
17
|
Bakan AB, Aslan G, Aka P. An investigation of the effect of the psychoeducation program provided to alexithymic and violent adolescents on the level of alexithymia. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:169-179. [PMID: 32662168 DOI: 10.1111/jcap.12285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/14/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
PROBLEM Alexithymia is defined as difficulties in defining and describing feelings, differentiating feelings and bodily sensations caused by emotional arousal, and a combination of constricted imaginary processes. This study aims to investigate the effect of the psychoeducation program provided to individuals with alexithymia and violent tendencies adolescents on the level of alexithymia. METHODS This experimental study was conducted between February 2019 and April 2019. The sample was 80 volunteer adolescents (experimental group n = 40 and control group n = 40) who met the research criteria. Data were collected using the Sociodemographic Form, the Tendency to Violence Scale, and the Alexithymia Questionnaire for Children (AQC). The psychoeducation program was applied in the experimental group in 90-min sessions once a week throughout 9 weeks. FINDINGS There was a statistically significant decrease in the AQC posttest mean scores after the training provided to the experimental group (p < .01). CONCLUSIONS The psychoeducation provided to adolescents was found to reduce the level of alexithymia. It is recommended that similar studies should be conducted with larger groups.
Collapse
Affiliation(s)
- Ayse B Bakan
- Department of Nursing, School of Health, Agri Ibrahim Cecen University, Agri, Turkey
| | - Gulpinar Aslan
- First and Immediate Aid Program, Agri Ibrahim Cecen University Health Services Vocational School, Agrı, Turkey
| | - Pinar Aka
- Therapy and Rehabilitation Program, Agri Ibrahim Cecen University Health Services Vocational School, Agrı, Turkey
| |
Collapse
|
18
|
Preece DA, Becerra R, Robinson K, Allan A, Boyes M, Chen W, Hasking P, Gross JJ. What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity. J Pers 2020; 88:1162-1176. [PMID: 32463926 DOI: 10.1111/jopy.12563] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE There is ongoing uncertainty about the structure and definition of alexithymia. Conceptually, alexithymia has traditionally been defined as a multidimensional trait with four components: difficulty identifying feelings, difficulty describing feelings, externally orientated thinking, and difficulty fantasizing. However, some authors suggest that difficulty fantasizing might not be a component, and others suggest low emotional reactivity is a fifth component. In this study, we sought to clarify this issue using factor analysis. METHOD In a sample of adults (N = 508), we administered a comprehensive battery of psychometric measures and analyzed their latent structure using exploratory factor analysis. RESULTS Subscales assessing difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking all loaded well together on the alexithymia factor. However, none of the subscales assessing aspects of difficulty fantasizing (i.e., daydreaming frequency, vividness, content, or use of daydreams to regulate emotions) loaded on the alexithymia factor. Similarly, no emotional reactivity subscales loaded on the alexithymia factor, and alexithymia was associated with higher (not lower) levels of emotional reactivity for negative emotions. CONCLUSIONS Difficulty fantasizing and low emotional reactivity are not components of the latent alexithymia construct. The traditional four-component definition of alexithymia likely warrants refinement to a more parsimonious three-component solution.
Collapse
Affiliation(s)
- David A Preece
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| | - Ken Robinson
- School of Psychology, Edith Cowan University, Perth, WA, Australia
| | - Alfred Allan
- School of Psychology, Edith Cowan University, Perth, WA, Australia
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Wai Chen
- Graduate School of Education, University of Western Australia, Perth, WA, Australia.,School of Medicine, University of Notre Dame Australia, Perth, WA, Australia.,Murdoch University, Perth, WA, Australia.,Mental Health Service, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| |
Collapse
|
19
|
Vergallito A, Mattavelli G, Gerfo EL, Anzani S, Rovagnati V, Speciale M, Vinai P, Vinai P, Vinai L, Lauro LJR. Explicit and Implicit Responses of Seeing Own vs. Others' Emotions: An Electromyographic Study on the Neurophysiological and Cognitive Basis of the Self-Mirroring Technique. Front Psychol 2020; 11:433. [PMID: 32296363 PMCID: PMC7136519 DOI: 10.3389/fpsyg.2020.00433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/25/2020] [Indexed: 01/29/2023] Open
Abstract
Facial mimicry is described by embodied cognition theories as a human mirror system-based neural mechanism underpinning emotion recognition. This could play a critical role in the Self-Mirroring Technique (SMT), a method used in psychotherapy to foster patients’ emotion recognition by showing them a video of their own face recorded during an emotionally salient moment. However, dissociation in facial mimicry during the perception of own and others’ emotions has not been investigated so far. In the present study, we measured electromyographic (EMG) activity from three facial muscles, namely, the zygomaticus major (ZM), the corrugator supercilii (CS), and the levator labii superioris (LLS) while participants were presented with video clips depicting their own face or other unknown faces expressing anger, happiness, sadness, disgust, fear, or a neutral emotion. The results showed that processing self vs. other expressions differently modulated emotion perception at the explicit and implicit muscular levels. Participants were significantly less accurate in recognizing their own vs. others’ neutral expressions and rated fearful, disgusted, and neutral expressions as more arousing in the self condition than in the other condition. Even facial EMG evidenced different activations for self vs. other facial expressions. Increased activation of the ZM muscle was found in the self condition compared to the other condition for anger and disgust. Activation of the CS muscle was lower for self than for others’ expressions during processing a happy, sad, fearful, or neutral emotion. Finally, the LLS muscle showed increased activation in the self condition compared to the other condition for sad and fearful expressions but increased activation in the other condition compared to the self condition for happy and neutral expressions. Taken together, our complex pattern of results suggests a dissociation at both the explicit and implicit levels in emotional processing of self vs. other emotions that, in the light of the Emotion in Context view, suggests that STM effectiveness is primarily due to a contextual–interpretative process that occurs before that facial mimicry takes place.
Collapse
Affiliation(s)
| | | | - Emanuele Lo Gerfo
- Clinical Psychology Service of Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCSS IsMeTT), Palermo, Italy
| | - Stefano Anzani
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Viola Rovagnati
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | - Piergiuseppe Vinai
- "GNOSIS" Research and Psychotherapy Group, Mondovì, Italy.,Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy.,Psicologia Scientifica - Centro di Ricerca e Promozione Sociale, Milan, Italy
| | - Paolo Vinai
- "GNOSIS" Research and Psychotherapy Group, Mondovì, Italy
| | - Luisa Vinai
- Pôle de Psychiatrie et Psychothérapie du Centre Hospitalier du Valais Romand, Monthey, Switzerland
| | - Leonor J Romero Lauro
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Milan, Italy.,Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
| |
Collapse
|
20
|
Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2019.109721] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
Pinna F, Manchia M, Paribello P, Carpiniello B. The Impact of Alexithymia on Treatment Response in Psychiatric Disorders: A Systematic Review. Front Psychiatry 2020; 11:311. [PMID: 32372987 PMCID: PMC7177022 DOI: 10.3389/fpsyt.2020.00311] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Treatment of psychiatric disorders relies heavily on a trial and error approach, often prolonging the time required to obtain symptomatic improvements. The identification of reliable predictors of treatment response is instrumental to enact an individualized approach. Alexithymia represents a personality trait reflecting an intrinsic difficulty in recognizing the emotional components of subjective experiences. Thus, its modulating role on treatment outcome has gathered substantial attention during the past years. In the present paper, we aimed at exploring the available evidence for Alexithymia role in influencing the treatment outcome on a wide range of psychiatric conditions by means of a systematic review. DATA SOURCE We performed a systematic review in Medline and Scopus, augmented by tracking the reference list of the pertinent articles. INCLUSION CRITERIA To be included in this review, research studies had to assess alexithymia impact on a treatment intervention delivered to manage a primary psychiatric disorder. STUDY EVALUATION AND DATA SYNTHESIS After removing duplicates, titles were screened first, then abstracts, and last full texts were read, eventually leading to the inclusion or exclusion of the papers according to the criteria established before the online search. Then results of the search were downloaded in.xml format and uploaded in Rayyan, a free web software, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. After uploading, screening of the literature was performed in blind by two investigators. Disagreement between reviewers was resolved by joint discussion with a third senior investigator. The quality of evidence was assessed using the Newcastle Ottawa Scale. Thereafter, the data considered relevant was extracted and synthetized in this paper. RESULTS Our search yielded a total of 30 articles dealing with a wide range of psychiatric conditions and exploring both pharmacological and psychotherapeutic interventions. Several lines of evidence suggest a complex role for alexithymia in influencing the psychiatric treatment outcome, further underscoring the need for additional research in this area to better address the existing knowledge gaps.
Collapse
Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| |
Collapse
|
22
|
Nonterah CW, Marek RJ, Borckardt JJ, Balliet WE. Impact of Alexithymia on Organ Transplant Candidates' Quality of Life: The Mediating Role of Depressive Symptoms. Psychol Rep 2019; 123:1614-1634. [PMID: 31856644 DOI: 10.1177/0033294119896058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid organ transplant candidates who display alexithymia tend to report psychological distress with some displaying symptoms associated with depression which in turn has a negative impact on their quality of life. This study sought to examine the mediating role of depression on the relationship between alexithymia and physical and psychological quality of life. The sample comprised 707 patients who were under consideration for solid organ transplantation. Mediation models were used to examine the proposed hypotheses, specifically that alexithymia would predict quality of life, and that depression would mediate the relationship between alexithymia and physical and psychological quality of life. Findings revealed that alexithymia predicted both physical and psychological quality of life. Depression scores partially mediated the relationship between alexithymia and both physical and psychological quality of life. Transplant candidates with higher levels of alexithymia who report poor physical and psychological quality of life may be at increased risk for depression. Results highlight the need to assess alexithymia within this unique patient population, who may understate symptoms of depression due to attempts at positive impression management.
Collapse
Affiliation(s)
| | - Ryan J Marek
- University of Houston-Clear Lake, Houston, TX, USA
| | | | | |
Collapse
|
23
|
Psychological Mindedness and Alexithymia Predict Symptom Reduction in Cognitive Behavior Therapy for Major Depressive Disorder. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00062-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Carcione A, Riccardi I, Bilotta E, Leone L, Pedone R, Conti L, Colle L, Fiore D, Nicolò G, Pellecchia G, Procacci M, Semerari A. Metacognition as a Predictor of Improvements in Personality Disorders. Front Psychol 2019; 10:170. [PMID: 30800084 PMCID: PMC6375846 DOI: 10.3389/fpsyg.2019.00170] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.
Collapse
Affiliation(s)
- Antonino Carcione
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Ilaria Riccardi
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Elena Bilotta
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Luigi Leone
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberto Pedone
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Laura Conti
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Livia Colle
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Donatella Fiore
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giovanni Pellecchia
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Michele Procacci
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy – Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| |
Collapse
|
25
|
Hemming L, Haddock G, Shaw J, Pratt D. Alexithymia and Its Associations With Depression, Suicidality, and Aggression: An Overview of the Literature. Front Psychiatry 2019; 10:203. [PMID: 31031655 PMCID: PMC6470633 DOI: 10.3389/fpsyt.2019.00203] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/20/2019] [Indexed: 11/21/2022] Open
Abstract
Depression affects around 4-10% of the general population in England. Depression can often lead to behaviors and thoughts related to suicide and aggression, which have a social and economic burden to the United Kingdom. One construct that has been theorized as having an association with these behaviors is alexithymia. People with alexithymia have difficulties identifying and describing their emotional experiences. To date, there is no consensus on types or causes of alexithymia. Whilst the literature evidences a strong relationship between alexithymia and suicidality and aggression, little is known about the nature of this relationship. The present article will attempt to describe the extant literature on this relationship, drawing out some of the contentions and unanswered questions.
Collapse
Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| |
Collapse
|
26
|
Preece D, Becerra R, Robinson K, Dandy J, Allan A. The psychometric assessment of alexithymia: Development and validation of the Perth Alexithymia Questionnaire. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
da Silva ACN, Vasco AB, Watson JC. Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases. RESEARCH IN PSYCHOTHERAPY (MILANO) 2018; 21:313. [PMID: 32913763 PMCID: PMC7451330 DOI: 10.4081/ripppo.2018.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/10/2018] [Indexed: 11/23/2022]
Abstract
Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.
Collapse
Affiliation(s)
- Ana Catarina Nunes da Silva
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Antonio Branco Vasco
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Jeanne C. Watson
- Ontario Institute for Studies in Education, University of Toronto, Canada
| |
Collapse
|
28
|
An Initial Study of Alexithymia and Its Relationship With Cognitive Abilities Among Mild Cognitive Impairment, Mild Alzheimer's Disease, and Healthy Volunteers. J Nerv Ment Dis 2018; 206:628-636. [PMID: 30020208 DOI: 10.1097/nmd.0000000000000853] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study examined the degree to which alexithymia is greater in mild Alzheimer's disease (AD) and mild cognitive impairment (MCI) relative to healthy volunteers (healthy comparison [HC]), and investigated relationships between alexithymia and cognition. Eighty-five participants (MCI = 30, AD = 21, HC = 34) underwent a comprehensive neuropsychological examination and completed the 20-item Toronto Alexithymia Scale (TAS-20). Relative to HC, MCI and AD reported greater alexithymia total scores and higher scores on the TAS factor difficulty in identifying feelings (DIF). The remaining two factors, difficulty in describing feelings (DDF) and externally oriented thinking showed no significant group differences. In MCI, TAS-20 and DIF were negatively correlated with working and long-term verbal memory. In AD, TAS-20 was negatively correlated with general cognition, attention, memory, and visual spatial constructive and executive abilities. Also in AD, DIF was negatively correlated with general cognition, memory, and executive abilities. The correlation between DIF and long-term verbal memory in both MCI and AD suggests a potential common mechanism for alexithymia in these neurocognitive disorders. Declines in verbal memory may hinder a patient's ability to recall an association between a given sensation and the episodic experience of that sensation, thus leading to difficulty identifying feelings, as measured by the DIF factor of the TAS-20.
Collapse
|
29
|
Maroti D, Lilliengren P, Bileviciute-Ljungar I. The Relationship Between Alexithymia and Emotional Awareness: A Meta-Analytic Review of the Correlation Between TAS-20 and LEAS. Front Psychol 2018; 9:453. [PMID: 29713295 PMCID: PMC5911526 DOI: 10.3389/fpsyg.2018.00453] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Alexithymia and emotional awareness may be considered overlapping constructs and both have been shown to be related to psychological and emotional well-being. However, it is not clear how the constructs relate to each other empirically or if they may overlap more or less in different populations. The aim of this review was therefore to conduct a meta-analysis of correlations between the most commonly used measures of alexithymia (i.e., the self-report instrument Toronto Alexithymia Scale; TAS-20) and emotional awareness (i.e., the observer-rated instrument Level of Emotional Awareness Scale; LEAS) and to explore potential moderators of their relationship. Methods: Electronic databases were searched for studies published until the end of February 2018. Study samples were coded as medical conditions, psychiatric disorders and/or healthy controls and sample mean age and gender distribution were extracted. Correlations between the TAS-20 and the LEAS were subjected to a random effect of meta-analysis and moderators were explored in subgroup analyses and meta-regressions. Publication bias was considered. Results: 21 studies reporting on 28 independent samples on correlation analysis were included, encompassing a total of 2857 subjects (57% women). The aggregated correlation between TAS-20 and LEAS was r = −0.122 (95% CI [−0.180, −0.064]; Z = −4.092; p < 0.001), indicating a significant, but weak, negative relationship between the measures. Heterogeneity was moderate, but we found no indication of significant differences between patients with medical conditions, psychiatric disorders or healthy controls, nor that mean age or percentage of female subjects moderated the relationship. The overall estimate became somewhat weaker after adjusting for possible publication bias. Conclusions: Our results indicate that TAS-20 and LEAS measure different aspects of emotional functioning. The small overlap suggests that alexithymia and emotional awareness are distinct constructs of emotional well-being. Clinicians need to assess both aspects when considering treatment options for individual patients. Moreover, from the clinical standpoint, an easy reliable and valid way of measuring emotional awareness is still needed. More research should be focus on the differences between alexithymia and emotional awareness in specific conditions, but also how to integrate self-report instrument and observed based measures in a clinical situation.
Collapse
Affiliation(s)
- Daniel Maroti
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
30
|
da Silva AN, Vasco AB, Watson JC. Alexithymia and emotional processing: a longitudinal mixed methods research. ACTA ACUST UNITED AC 2018; 21:292. [PMID: 32913756 PMCID: PMC7451369 DOI: 10.4081/ripppo.2018.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 12/03/2022]
Abstract
Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients processing emotions and engaging in emotional tasks. The possibility of alexithymia being modified by psychotherapy remains a topic of great debate but with little empirical research. In this study a mixed methods longitudinal design was used to better understand alexithymia, emotional processing and change process in psychotherapy. Twelve clients, five with alexithymia, were studied considering the development of alexithymia, emotional awareness, differentiation, regulation and severity of symptoms. The reliable change index was used to interpret the evolution of those emotional variables’ scores for each case and thematic analysis was used to analyze individual interviews. Thematic analysis generated several themes, organized in two broad domains: i) perception of emotions and ii) description of change. The three alexithymic patients that changed in alexithymia also changed in at least one of the emotional variables – lack of emotional awareness, emotion differentiation or emotion regulation. Generally, alexithymic patients were able to accomplish change in psychotherapy although they had a tendency to focus on physical complaints, describe changes in a more rational rather than emotional way and present vaguer descriptions of their problems. These results point that alexithymia may change through therapy and reinforces that those changes are associated with improved emotional processing.
Collapse
Affiliation(s)
| | | | - Jeanne C Watson
- Ontario Institute for Studies in Education, University of Toronto, Canada
| |
Collapse
|
31
|
Burns EJ. Do terrorists suffer from alexithymia? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:100-103. [PMID: 29417660 DOI: 10.1002/cbm.2060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/19/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Edwin J Burns
- Division of Psychology, Nanyang Technological University, 14 Nanyang Drive, Singapore
| |
Collapse
|
32
|
Cruise KE, Becerra R. Alexithymia and problematic alcohol use: A critical update. Addict Behav 2018; 77:232-246. [PMID: 29107201 DOI: 10.1016/j.addbeh.2017.09.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 01/09/2023]
Abstract
There has been a substantial growth in empirical research aimed at examining the co-occurrence of alexithymia and problematic alcohol use and alcohol use disorder (AUD) since Thorberg, Young, Sullivan, and Lyvers (2009) original review article. The objective of the present paper is therefore to provide a critical update review of research on alexithymia and problematic alcohol use published since 2009. A systematic search was conducted through PsychINFO, Medline, and ProQuest databases to obtain relevant literature published between 2009 and 2016. Studies that involved measures of alexithymia and problematic alcohol use among clinical and non-clinical samples were included. Prevalence rates of alexithymia among Alcohol Dependent (AD) samples were identified between 30 and 49%, and were therefore much lower than originally reported. The findings of this update review highlight an indirect relationship between alexithymia and alcohol problem severity that is mediated by a number of psychological drinking constructs (e.g., alcohol expectancy, drinking motives, craving and alcohol related intrusive thoughts) and psychological risk factors for the development of alcohol related problems (e.g., mood and emotion dysregulation, attachment, trauma, and cognitive function). In addition, this review provides reasonable evidence to support alexithymia as an independent risk factor for alcohol related problems among clinical samples only. In conclusion, alexithymia is a multifaceted construct that has a complex relationship with various risk factors and psychological drinking constructs. The growing body of research highlights the demand for understanding the interrelationships between alexithymia, psychosocial risk factors, and problematic alcohol use in order to tailor and target therapeutic interventions.
Collapse
Affiliation(s)
- K E Cruise
- School of Psychology and Social Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
| | - R Becerra
- School of Psychology and Social Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
| |
Collapse
|
33
|
de Vroege L, Emons WHM, Sijtsma K, van der Feltz-Cornelis CM. Alexithymia Has No Clinically Relevant Association With Outcome of Multimodal Treatment Tailored to Needs of Patients Suffering From Somatic Symptom and Related Disorders. A Clinical Prospective Study. Front Psychiatry 2018; 9:292. [PMID: 30087625 PMCID: PMC6066688 DOI: 10.3389/fpsyt.2018.00292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 06/12/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Alexithymia may moderate the effectiveness of treatment and may predict impaired general functioning of patients suffering from somatic symptom and related disorders (SSRD). Aim: We compared alexithymia levels in a clinical prospective study with 234 consecutive patients suffering from SSRD from the Centre of Excellence for Body, Mind, and Health, Tilburg using the Bermond-Vorst Alexithymia Questionnaire, with general population norm scores. Second, we explored treatment outcomes of a multimodal treatment tailored to patient needs by Shared Decision Making (SDM) and Patient Related Outcome Monitoring (PROM) in patients with SSRD. Third, we explored whether alexithymia is associated with treatment outcome. Fourth, we explored if the presence of a chronic medical condition (e.g., diabetes mellitus, cardiovascular diseases) affects the association of alexithymia with treatment outcomes. Results: Compared to norm scores, SSRD patients showed elevated scores on the subscales identifying, verbalizing, and fantasizing, and on the cognitive dimension. All patients benefited from treatment in terms of anxiety, depression, and physical symptoms. The association of alexithymia with treatment outcome was significant, but the effect size was negligible (range odds ratios 1.02-1.25). The association between alexithymia and treatment outcome was stronger in patients suffering from chronic medical conditions compared to patients without chronic medical conditions. However, the effect size of this association was negligible (range odds ratio 0.94-1.12). Discussion: Alexithymia scores are elevated in patients with SSRD compared to general population scores, but the level of alexithymia has no clinically relevant association with treatment outcome both in SSRD patients with and without comorbid chronic medical conditions.
Collapse
Affiliation(s)
- Lars de Vroege
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands
| | - Wilco H M Emons
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Klaas Sijtsma
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Christina M van der Feltz-Cornelis
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| |
Collapse
|
34
|
Samuel DB, Bucher MA, Suzuki T. A Preliminary Probe of Personality Predicting Psychotherapy Outcomes: Perspectives from Therapists and Their Clients. Psychopathology 2018; 51:122-129. [PMID: 29635236 DOI: 10.1159/000487362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is widely established that personality disorder has as broad negative impact on psychotherapy outcomes. Given the increased emphasis on dimensional traits for personality pathology in the DSM-5 and the proposal for the ICD-11, it is important to understand how traits are linked to treatment outcomes. Building on past research with general traits, we hypothesized that more nuanced and specific relations would be apparent. Furthermore, much of the past research has relied upon self-reports of personality and little is known about how ratings from therapists might be related to outcomes. SAMPLING AND METHODS The present paper examined how dimensional traits from the Five-Factor Model predicted outcomes in a case series of 54 therapist-client dyads within a doctoral training clinic. Importantly, this extends past research as dimensional traits were rated by both therapists and clients at intake as well as sequentially over the course of therapy. RESULTS Correlations and regression analyses indicated that traits predicted a variety of outcomes including initial engagement in treatment as well as overall symptom reduction across therapy. Specifically, preliminary evidence suggests that therapist-rated conscientiousness at intake was positively related to clients' early engagement in therapy. In addition, openness to experience after the 4th session - particularly as rated by the client - was predictive of long-term therapy outcomes. CONCLUSIONS Broadly, these results provided preliminary information about the promise of dimensional models for improving the clinical utility of personality disorder diagnoses. More specifically, these results reinforced the relevance of personality assessment during therapy and indicated the potential predictive value of ratings by therapists and their clients.
Collapse
|
35
|
Assessing Alexithymia: Psychometric Properties and Factorial Invariance of the 20-Item Toronto Alexithymia Scale in Nonclinical and Psychiatric Samples. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9634-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Quilty LC, Taylor GJ, McBride C, Bagby RM. Relationships among alexithymia, therapeutic alliance, and psychotherapy outcome in major depressive disorder. Psychiatry Res 2017; 254:75-79. [PMID: 28456025 DOI: 10.1016/j.psychres.2017.04.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/07/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
Previous studies have found that alexithymia predicts process and outcome of psychodynamic psychotherapy across a range of psychiatric disorders. There is preliminary evidence that alexithymia may exert its effects on outcome through the therapist. Other studies have found that alexithymia does not influence outcome of cognitive-behavioral therapy (CBT). The aim of the current study was to investigate the capacity of alexithymia to predict therapist- and patient-rated therapeutic alliance and response to CBT and interpersonal psychotherapy (IPT) for major depressive disorder. A total of 75 adults with major depressive disorder were randomized to receive weekly sessions of manualized individual CBT or IPT for a period of 16 weeks. Pre-treatment alexithymia exhibited a positive direct effect on depression change, and a negative indirect effect on depression change via patient-rated alliance at week 13. There was no mediating role of therapist-rated alliance. Although these findings are preliminary, they suggest that pre-treatment alexithymia has meaningful links to psychotherapy process and outcome, and that nuanced analyses incorporating intervening variables are necessary to elucidate the nature of these links.
Collapse
Affiliation(s)
- Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street Toronto, ON, Canada M5T 1R8.
| | - Graeme J Taylor
- Department of Psychiatry, University of Toronto, 250 College Street Toronto, ON, Canada M5T 1R8; Department of Psychiatry, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada M5G 1X5
| | - Carolina McBride
- Department of Psychiatry, University of Toronto, 250 College Street Toronto, ON, Canada M5T 1R8
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, 250 College Street Toronto, ON, Canada M5T 1R8; Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON, Canada M5S 3G3
| |
Collapse
|
37
|
Jensen HH, Mortensen EL, Lotz M. Predictors of non-responding in short-term psychodynamic group therapy. NORDIC PSYCHOLOGY 2017. [DOI: 10.1080/19012276.2017.1323664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hans Henrik Jensen
- Medical Psychology Unit, Faculty of Health and Medical Sciences, Department of Public Health , University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Medical Psychology Unit, Faculty of Health and Medical Sciences, Department of Public Health , University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lotz
- Psychiatric Department, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
38
|
McGillivray L, Becerra R, Harms C. Prevalence and Demographic Correlates of Alexithymia: A Comparison Between Australian Psychiatric and Community Samples. J Clin Psychol 2016; 73:76-87. [DOI: 10.1002/jclp.22314] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Rodrigo Becerra
- Edith Cowan University; Western Australia
- Fremantle Adult Mental Health Services
| | | |
Collapse
|
39
|
Terock J, Janowitz D, Spitzer C, Miertsch M, Freyberger HJ, Grabe HJ. Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome. Compr Psychiatry 2015; 62:34-41. [PMID: 26343465 DOI: 10.1016/j.comppsych.2015.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/28/2015] [Accepted: 06/06/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alexithymia, a common personality style of patients seeking psychotherapeutic help, is associated with illness severity and negative treatment outcome in various mental disorders. Still, it remains unclear how alexithymia influences psychopathology and the therapeutic processes. In previous studies, a strong association of alexithymia with self-directedness (SD), a dimension of Cloninger's Temperament and Character Inventory (TCI) has been shown. In this study, we investigated the interaction of alexithymia and SD, and their impact on general psychopathology and on treatment outcome. METHOD 716 consecutively admitted day-clinic outpatients were examined at admission (t0) and discharge (t1). The Toronto Alexithymia Scale 20 (TAS-20), the SD subscale of the TCI and the Symptom Checklist 90 (SCL-90-R) were administered. Linear regression analyses were performed to calculate associations and the predictive power of TAS-20 and SD on psychopathology at admission and treatment outcome. ANOVA was used to calculate interactions of TAS-20 and SD on treatment outcome. A general linear model was applied to compare the outcome of four subgroups, defined by high/low TAS-20 and SD scores. RESULTS Regression analyses revealed significant prediction of the baseline General Severity Index (GSIt0) by TAS-20 (df=4, 711; Beta: 0.385; p<0.001) and SD (Beta: -0.365; p<0.001). The whole model accounted for 41% of the explained variance. On subscale level, the 'Difficulties in identifying feelings' facet (DIF) of TAS-20 was the strongest predictor of GSIt0 (Beta: 0.478, P<0.001) and GSIt1 (Beta: 0.072, p=0.049). Therapeutic outcome measured by GSIt1 was significantly predicted by SD (df=5, 710; Beta: -0.065; p=0.041), but not by TAS-20 (Beta: 0.042; p=0.179). Change scores (∆) of TAS-20 and SD predicted GSIt1 (df=5, 710; TAS-20∆ Beta: -0.268; p<0.001; SD∆ Beta: 0.191; p<0.001) as well as GSI∆ (df=5, 710; TAS∆ Beta: 0.384; p<0.001; SD∆: -0.274; p<0.001) significantly. ANOVA revealed no significant interactions of TAS-20 and SD at admission on the treatment outcome (p>0.05). CONCLUSION Low SD was shown to be a common problem of alexithymic patients and both, alexithymia and SD were highly associated with general symptom severity. SD was found to have a greater impact on treatment outcome while adjusting for baseline GSI. Alexithymia and SD act as independent factors with no significant interaction in their impact on psychopathology at admission and discharge. As different interventions were shown to improve SD scores in previous studies, SD may represent a relevant psychotherapeutic target, worthy to be addressed especially in alexithymic patients. Future studies should investigate other dimensions of the TCI, especially harm avoidance and reward dependence.
Collapse
Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany.
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | | | - Martin Miertsch
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| |
Collapse
|
40
|
Monti JD, Rudolph KD. Emotional awareness as a pathway linking adult attachment to subsequent depression. J Couns Psychol 2015; 61:374-82. [PMID: 25019541 DOI: 10.1037/cou0000016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although research links insecure adult attachment with depression, the emotional processes accounting for this association over time remain relatively unexplored. To address this gap, this study investigated whether deficits in emotional awareness serve as one explanatory process. Adult female caregivers (N = 417, Mage = 37.83) completed questionnaires annually for 3 years. As anticipated, attachment avoidance exerted an indirect effect on depression via emotional awareness. Attachment anxiety directly predicted subsequent depression, but the indirect effect through emotional awareness was nonsignificant. These results suggest that an avoidant attachment style interferes with the effective processing of emotions, thereby placing women at risk for depression. This research implicates emotional awareness as a potential target for interventions aimed at reducing depressive symptoms in mothers with avoidant attachment styles.
Collapse
Affiliation(s)
- Jennifer D Monti
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Karen D Rudolph
- Department of Psychology, University of Illinois at Urbana-Champaign
| |
Collapse
|
41
|
Joyce AS, Nordhagen A, Ogrodniczuk JS, Stovel LE, Bjorge A. Partial Hospitalization Treatment of the Alexithymic Patient: A Case Study. J Clin Psychol 2015; 71:167-77. [DOI: 10.1002/jclp.22152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
42
|
Pinna F, Sanna L, Carpiniello B. Alexithymia in eating disorders: therapeutic implications. Psychol Res Behav Manag 2014; 8:1-15. [PMID: 25565909 PMCID: PMC4278740 DOI: 10.2147/prbm.s52656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A high percentage of individuals affected by eating disorders (ED) achieve incomplete recovery following treatment. In an attempt to improve treatment outcome, it is crucial that predictors of outcome are identified, and personalized care approaches established in line with new treatment targets, thus facilitating patient access to evidence-based treatments. Among the psychological factors proposed as predictors of outcome in ED, alexithymia is of outstanding interest. The objective of this paper is to undertake a systematic review of the literature relating to alexithymia, specifically in terms of the implications for treatment of ED. In particular, issues concerning the role of alexithymia as a predictor of outcome and as a factor to be taken into account in the choice of treatment will be addressed. The effect of treatments on alexithymia will also be considered. A search of all relevant literature published in English using PubMed, PsycINFO, and Scopus databases was carried out on the basis of the following keywords: alexithymia, anorexia nervosa, bulimia nervosa, eating disorders, and treatment; no time limits were imposed. Despite the clinical relevance of alexithymia, the number of studies published on the above cited aspects is somewhat limited, and these studies are largely heterogeneous and feature significant methodological weaknesses. Overall, data currently available mostly correlate higher levels of alexithymia with a less favorable outcome in ED. Accordingly, alexithymia is seen as a relevant treatment target with the aim of achieving recovery of these patients. Treatments focusing on improving alexithymic traits, and specifically those targeting emotions, seem to show greater efficacy, although alexithymia levels often remain high even after specific treatment. Further investigations are needed to overcome the methodological limitations of previous studies, to understand the actual impact of alexithymia on ED outcome, and to allow more precise implications for treatment to be drawn. Additional research should also be undertaken to specify which of the alexithymic dimensions are specifically relevant to the course and outcome of ED, and to identify treatment protocols producing a significantly greater efficacy in ED patients with relevant alexithymic traits.
Collapse
Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Lucia Sanna
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| |
Collapse
|
43
|
Abstract
Alexithymia, a deficit characterized by difficulties identifying, differentiating, and articulating emotions, is associated with significant physical and mental health impairment. It is generally accepted that alexithymia has a negative impact on a variety of physical and mental health treatments. Less clear is the extent to which alexithymia itself can be modified. In this article we review studies that have examined the effects of psychological interventions on alexithymia. Taken together, findings from investigations included in this review suggest that alexithymia is partly modifiable with therapeutic interventions. Studies that directly targeted alexithymic symptoms tended to report significant reductions in alexithymia scores following treatment, whereas studies that measured changes in alexithymia but did not employ any psychological interventions specifically intended to treat alexithymia had more inconsistent results. We close by considering the practical implications of the findings, and by offering suggestions for future research.
Collapse
|
44
|
Darrow SM, Follette WC. A Behavior Analytic Interpretation of Alexithymia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2014; 3:98-108. [PMID: 25473602 PMCID: PMC4248666 DOI: 10.1016/j.jcbs.2014.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Alexithymia is a term used to describe individuals who seem unable to experience or at least describe emotions. This paper offers a theoretical interpretation of alexithymia from a radical behaviorist perspective. While there have been attempts to explain the etiology of alexithymia, the current analysis is unique in that it provides direct treatment implications. The pragmatic analysis described focuses on the verbal behavior of individuals rather than looking "inside" for explanations. This is supported by a review of experimental research that has failed to find consistencies among alexithymic individuals' physiological responding. Descriptions of the various discriminative and consequential stimulus conditions involved in the complex learning histories of individuals that could result in an alexithymic presentation are provided. This analysis helps situate the alexithymia construct in a broader behavior analytic understanding of emotions. Finally this paper outlines implications for assessment and treatment, which involve influencing discriminative and consequential interpersonal stimulus conditions to shape verbal behavior about emotions.
Collapse
Affiliation(s)
- Sabrina M. Darrow
- University of Nevada, Reno, Department of Psychology/MS 298, University of Nevada, Reno, Reno, NV 89557, USA
| | - William C. Follette
- University of Nevada, Reno, Department of Psychology/MS 298, University of Nevada, Reno, Reno, NV 89557, USA
| |
Collapse
|
45
|
Gullestad FS, Johansen MS, Høglend P, Karterud S, Wilberg T. Mentalization as a moderator of treatment effects: Findings from a randomized clinical trial for personality disorders. Psychother Res 2013; 23:674-89. [DOI: 10.1080/10503307.2012.684103] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
46
|
Lane A, Luminet O, Rimé B, Gross JJ, de Timary P, Mikolajczak M. Oxytocin increases willingness to socially share one's emotions. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 48:676-81. [DOI: 10.1080/00207594.2012.677540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
47
|
Kojima M. Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies. Biopsychosoc Med 2012; 6:21. [PMID: 23244192 PMCID: PMC3546882 DOI: 10.1186/1751-0759-6-21] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022] Open
Abstract
The number of articles on alexithymia has been steadily increasing since the word “alexithymia” was coined in the 1970s to denote a common characteristic that is observed among classic psychosomatic patients in whom therapy was unsuccessful. Alexithymia, a disorder of affect regulation, has been suggested to be broadly associated with various mental and physical health problems. However, most available evidence is based on anecdotal reports or cross-sectional observations. To clarify the predictive value of alexithymia for health problems, a systematic review of prospective studies was conducted. A search of the PubMed database identified 1,507 articles on “alexithymia” that were published by July 31, 2011. Among them, only 7 studies examined the developmental risks of alexithymia for health problems among nonclinical populations and 38 studies examined the prognostic value of alexithymia among clinical populations. Approximately half of the studies reported statistically significant adverse effects, while 5 studies demonstrated favorable effects of alexithymia on health outcomes; four of them were associated with surgical interventions and two involved cancer patients. The studies that showed insignificant results tended to have a small sample size. In conclusion, epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems remains un-established. Even though alexithymia is considered to be an unfavorable characteristic for disease control and health promotion overall, some beneficial aspects are suggested. More prospective studies with sufficient sample sizes and follow-up period, especially those involving life course analyses, are needed to confirm the contribution of alexithymia to health problems.
Collapse
Affiliation(s)
- Masayo Kojima
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| |
Collapse
|
48
|
Solbakken OA, Hansen RS, Havik OE, Monsen JT. Affect integration as a predictor of change: Affect consciousness and treatment response in open-ended psychotherapy. Psychother Res 2012; 22:656-72. [DOI: 10.1080/10503307.2012.700871] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
49
|
Ogrodniczuk JS, Sochting I, Piper WE, Joyce AS. A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program. Psychol Psychother 2012; 85:278-91. [PMID: 22903919 DOI: 10.1111/j.2044-8341.2011.02032.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning. DESIGN AND METHODS Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms. RESULTS Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period. CONCLUSIONS The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.
Collapse
Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | |
Collapse
|
50
|
Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res 2011; 190:43-8. [PMID: 20471096 DOI: 10.1016/j.psychres.2010.04.026] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 03/18/2010] [Accepted: 04/18/2010] [Indexed: 10/19/2022]
Abstract
Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.
Collapse
Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Suite 420 - 5950 University Boulevard, Vancouver, BC, Canada.
| | | | | |
Collapse
|